Here’s why hyperpigmentation and melasma aren’t the same

Not every instance of skin discolouration can be deduced as ‘hyperpigmentation’. We ask dermatologists to understand what differentiates pigmentation from melasma 

According to a survey conducted by the National Institutes of Health, about 80 per cent of the Indian population exhibits some or the other type of pigmentation. A quick conversation with a dermatologist will corroborate the fact that an uneven skin tone and pigmentation are common phenomena in the case of melanin-rich skin, which is what most—if not all—of the Indian skin identifies as. Pigmentation, however, is a blanket terminology—its broad spectrum includes dark spots, dark, blotchy patches, freckles, discolouration and more. Melasma, a type of pigmentation, can therefore, more often than not, be misconstrued as just any other form of hyperpigmentation. From the trigger points to the treatment plan, there’s a difference between melasma and hyperpigmentation. We ask two dermatologists to help us understand the variations between them and how you can effectively treat both. 

What is hyperpigmentation?

Defining hyperpigmentation, Hyderabad-based dermatologist and founder of Glow Clinic, Dr Varshini Reddy, says, “It is a condition that causes the skin to darken due to increased melanin production, and can stem from various underlying causes.” Dr Sravya Tipirneni, consultant dermatologist, cosmetologist and trichologist at Manipal Hospitals, Bengaluru, explains the fundamental difference between pigmentation and hyperpigmentation. While pigmentation is the natural colouration of the skin, influenced by the natural production of melanin, a pigment that gives skin its colour, in the body, hyperpigmentation is a condition that occurs when there is an overproduction of melanin. The overproduction then leads to dark spots or patches on the skin.

What is melasma?

From Kim Kardashian to Emma Roberts to Jenna Dewan, a handful of celebrities have opened up about their respective journeys with hyperpigmentation, and melasma in particular. Even though melasma may champion the characteristics of hyperpigmentation, there’s a lot that can transpire differently in its case. “Melasma is a chronic pigmentary disorder characterised by the development of brown patches on the skin. It’s also commonly known as chloasma or ‘mask of pregnancy’ as it frequently affects pregnant women,” explains Reddy.

Melasma patches typically appear on the face, mostly on the cheeks, forehead and nose, albeit, they can also occur on other sun-exposed areas, adds the dermatologist. It is of three types, based on the depth and intensity of the pigmentation, namely—epidermal, dermal and mixed. “An instrument called a wood’s lamp is used to determine the depth of the pigment. Remember, epidermal melasma responds better to treatment than the other two variants,” states Reddy. Tipirneni adds that melasma is often triggered by sun exposure, hormonal changes or certain medications.

Hyperpigmentation versus melasma

Let’s be honest—it’s often tough to ferret out whether the brown spots or patches surfacing on the skin fall under the bracket of melasma or hyperpigmentation on face value. As Reddy mentioned earlier, a thorough assessment by a skincare professional would be the best way to determine what exactly your skin has fallen prey to. “Hyperpigmentation is a broad umbrella term which can characterise various pigmentary disorders including melasma,” clarifies Reddy. “However, while hyperpigmentation doesn’t follow a significant pattern, melasma does—it involves a typical presentation with well-defined brown patches over the face and sun-exposed areas of the skin,” says Reddy, sharing that this very unique demarcation [of pigmentation] helps them decipher the underlying concern of the hyperpigmentation.

“The main difference between melasma and hyperpigmentation is the cause,” reiterates Tipirneni. “Hyperpigmentation can be caused by a variety of factors, including sun exposure, injury, and certain medications; melasma, on the other hand, is most commonly caused by sun exposure and hormonal changes.” Reddy also agrees that melasma is associated with triggers that are unique from general hyperpigmentation. “The hormonal changes include pregnancy, menopause, a frequent use of birth control pills, UV exposure and, sometimes, heat too.” 

Does the treatment also vary?

There indeed is a slight difference in the treatment approach of melasma and other pigmentary conditions, admits Reddy. “To treat melasma, we ensure to not use heat or high laser energy as this can further worsen the pigment, given that heat triggers melasma. It also has an inflammatory component which can be treated with certain devices [that offer anti-inflammatory benefits]. It requires a long-term treatment plan using a combination of peels for superficial resurfacing and lasers with low-energy parameters as long-term maintenance,” explains Reddy, adding that it is advisable to consult an experienced dermatologist who is skilled to treat melasma in the long run.

In the course of treatment for melasma, it is important to avoid sun exposure and to use sunscreen with an SPF of 30 or higher, mentions Tipirneni. “Topical creams that contain hydroquinone, azelaic acid or kojic acid may also be helpful.” As far as hyperpigmentation is concerned, the treatment will depend on the cause. “If the hyperpigmentation is caused by sun exposure, it is important to wear sunscreen and to avoid sun exposure,” says the doctor. However, chemical active ingredients such as vitamin C, glycolic acid, niacinamide and other antioxidants can be meaningful additions to your everyday skincare routine to ensure you’re working towards tackling the discolouration slowly, on a daily basis.

Plan of treatment

Besides following a daily skincare routine, there are a few other treatment plans that might be worth exploring. At Reddy’s Glow Clinic, a combination of depigmenting chemical peels and laser therapies—which include Q-switched nanosecond lasers, picosecond lasers targeting melanin, resurfacing lasers and micro-needling—are employed to accelerate the skin’s reparative process. Enumerating her most-prescribed treatment options, Tipirneni mentions laser therapy (which targets and destroys melanin in the skin), light therapy (that reduces inflammation and evens out the skin), chemical peels (that remove the top layer of skin and reveal smoother, fresher skin) and microdermabrasion (that works similarly to chemical peels).

“In some cases, melasma may require ingestible medicines. The medication is usually prescribed by a dermatologist and can help to reduce inflammation and even out the skin,” informs Tipirneni. Explaining how you can decipher whether the unfamiliar pigmentation on your skin is hyperpigmentation or melasma, she says, “If you notice dark spots or patches on your skin, it is important to visit a dermatologist, who can perform a physical exam and may also use a wood's lamp to examine your skin. Treatment for melasma can be effective, but it is important to be patient and to continue treatment for several months.”

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